Nursing Care Plan - Diarrhea : Assessment and Diagnosis

Nursing Care Plan for Diarrhea

Diarrhea is a disease characterized by increased frequency of defecation more than usual (more than 3 times / day) accompanied by a change in stool consistency (a liquid), with / without blood and / or mucus (Suraatmaja, 2007).

Around the world there are approximately 500 million children suffer from diarrhea each year, and 20% of all deaths in children living in developing countries associated with diarrhea and dehydration. Diarrheal disorders can involve the stomach and intestines (gastroenteritis), small intestine (enteritis), colon (colitis) or colon and intestines (enterocolitis). Diarrhea is usually classified as acute and chronic diarrhea (Wong, 2009).

Diarrhea is a condition of increased fecal weight (more than 200 mg / day) which can be attributed to increased fluid, the frequency of bowel movement, not feeling the perianal, and a sense of urgency for bowel movements with or without fecal incontinence. Diarrhea is divided into Acute and Chronic diarrhea. Acute diarrhea lasts 2 weeks or less, while chronic diarrhea duration of more than 2 weeks. Further discussion regarding devoted chronic diarrhea (Hooward, 1995 cit Sutadi 2003).


Classification

According to WHO (2005) diarrhea can be classified to:

• Acute diarrhea, ie diarrhea lasting less than 14 days.
• Dysentery, the diarrhea is accompanied by blood.
• Persistent diarrhea, the diarrhea that lasts more than 14 days.
• Diarrhea accompanied by severe malnutrition.

According to Ahlquist and Camilleri (2005), diarrhea divided into:

• Acute, if less than 2 weeks, persistent if it lasts for 2-4 weeks. More than 90% of the causes of acute diarrhea are the causative agents of infectious and will be accompanied by vomiting, fever and abdominal pain. 10% were caused by the treatment, intoxication, ischemia and other conditions.
• Chronic, if it lasts more than 4 weeks. In contrast to acute diarrhea, a common cause of chronic diarrhea caused by non-infectious causes such as allergic and others.

According Kliegman, Marcdante and Jenson (2006), states that based on the amount of loss of fluid and electrolytes from the body, diarrhea can be divided into:

• Diarrhea without dehydration: At this rate of diarrhea sufferers do not become dehydrated because of diarrhea frequency is still within tolerable limits and there are no signs of dehydration.
• Diarrhea with mild dehydration (3% -5%): At this level patients with diarrhea 3 times or more, sometimes vomiting, thirsty, have decreased urination, decreased appetite, activity has begun to decline, the pressure pulse is normal or tachycardia minimum and a physical examination within normal limits.
• Diarrhea with moderate dehydration (5% -10%): In this situation, the patient will experience tachycardia, urinating less or no, irritability or lethargy, eye and large fontanel becomes concave, reduced skin turgor, mucous membranes of the lips and mouth and the skin appears dry, reduced tear and the elongated capillary refill (greater or equal to 2 seconds) with skin cold and pale.
• Diarrhea with severe dehydration (10% -15%): In this situation, the patient has lost a lot of fluid from the body and is usually in a state of patients experienced tachycardia with weak pulse, hypotension and pulse pressure spreads, no urine output, eyes and large fontanel becomes very concave, no tear production, not being able to drink and the situation began to apathy, decreased consciousness and also the very elongated capillary refill (greater or equal to 3 seconds) with a cold and pale skin.

Nursing Care Plan for Diarrhea

Assessment

1. Identity
Noteworthy is the age. Episodes of diarrhea occurred in the first 2 years of life. Highest incidence is 6-11 months age group. Most bacteria stimulate gut immunity against infection, it helps explain the decline insidence disease in older children. At the age of 2 years or more of active immunity begins to form. Most cases are due to intestinal infection and asymptomatic enteric bacteria spread mainly clients are not aware of the infection. Economic status also influential, especially from the diet and treatment.

2 The main complaint
Defecate more than 3 times, vomiting, diarrhea, bloating, fever.

3. History of present illness
Defecating yellow-green color, mixed with mucus and blood or mucus only. Watery consistency, frequency is more than 3 times, spending time: 3-5 days (acute diarrhea), more than 7 days (prolonged diarrhea), more than 14 days (chronic diarrhea).

4. Past medical history
Never before have diarrhea, use of antibiotics or corticosteroids long term (candida albicans changes from saprophyte become parasites), food allergies, respiratory infections, UTI, OMA measles.

5. History of nutrition
At toddler age children are given food as in adults, the portion given 3 times per day with additional fruit and milk. Malnutrition in children toddler age are particularly vulnerable. The way good food management, food hygiene and sanitation, hand washing habits.

6. Family health history
There is one family that is experiencing diarrhea.

7 History of environmental health
Food storage at room temperature, less hygiene, neighborhood.


Nursing Diagnosis for Diarrhea

1. Diarrhea
2. Hyperthermia
3. Deficient Fluid Volume
4. Anxiety: parents
5. Deficient Knowledge : on diarrheal disease
6. Decreased cardiac output
7. Ineffective breathing pattern
8. Activity intolerance

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Nursing Care Plan for Endocarditis

Nursing Diagnosis for Endocarditis

Endocarditis is an inflammation of the endocardium (the membrane that lies in the heart).

Causes

Endocarditis more often caused by bacteria, fungi, or other microorganisms, can be caused by the operation; resulting from intravenous injection using dirty needles or through wounds found on the skin and mucous. Organisms can run in the blood flow towards the heart. As a result, the heart valves become inflamed, valves become damaged, and the formation of blood clots in the infected area. A person who has suffered injury or illness in the endocardium the easier it is for people suffering from endocarditis. This caused a blood clot from the surface of a wound can adsorb microorganisms, which can reproduce more and more on the injured area. Intravenous drug could cure endocarditis.

Symptoms

Endocarditis can be found in the acute or subacute form. In the subacute form, general and non-specific symptoms, including stiffness, fever, and pain. On physical examination, the evidence is just an abnormality of heart murmurs. Acute endocarditis is less happening can occur suddenly and cause a short breathing, fever, high fever, rapid heartbeat and irregular. Infection can be easily expanded and can destroy the valves of the heart, causing heart failure.


Test and Diagnosis

Various test and diagnosis done is:

• Blood test.
• Echocardiogram.
• Electrocardiogram.
• X-ray of the chest.
• CT and MRI scans.

Nursing Diagnosis for Endocarditis

1. Acute pain related to systemic effects of the infection.
2. Risk for decreased cardiac output related to disturbances in heart valve and the endothelium.
3. Risk for Imbalanced Body Temperature.
4. Risk for Ineffective Tissue perfusion related to embolization

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Cephalalgia

Cephalalgia is a condition of pain in the head: sometimes a pain in the back of the neck or back top, also known as headache. These diseases include the grievances of the disease is often raised.

Headache is a universal problem, with a prevalence of nearly 99%, and is the most common reason for neurological referral. Headaches can have little clinical significance, but also may be a sign of the presence of life-threatening diseases. Pain in the head caused by traction / withdrawal, migration, inflammation, spasme of blood vessels, or distention of the head or neck structures that are sensitive to pain.

One type of headache that is often the Complaint is headache or migraine. Migraine attack feels tormented and sometimes sudden. Migraine sufferer will feel pain and throbbing like beaten and pulled and is usually accompanied with GI tract disorders such as nausea and vomiting. Patients tend to be more sensitive to light, sound and scent. It was certainly very disturbing and can inhibit the activity of the patients.

Migraine attacks can occur several times a year to a few times a week, with attacks usually 1-2 hours long. Migraine or headache the actual cause is not yet known with certainty. However, the predicted type of headache is caused due to a brain hiperaktifitas electric impulses that increase blood flow in the brain which results in dilation of the blood vessels of the brain and the process of inflammation (inflammatory lesions). There is also a tension-type headaches (tension type headache, or TTH) characteristics are both sides of the head as diremas with strong, but not accompanied by other symptoms (no nausea, vomiting, light sensitivity, etc.).

Most headaches are primary that is, without any underlying diseases such as migraine, cluster, and tension type headaches. However there is also a headache caused by an underlying disease process or condition or commonly called secondary headaches, which this case should be the focus early in the diagnostic evaluation of headache. Manifestation of an underlying systemic disease can help in the diagnosis of the etiology of headache and should always be sought. Because if up late can be fatal.

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Constipation Care Plan - Nursing

Constipation

Constipation is a disorder of the digestive system where a person experiencing excessive hardening of feces making it difficult to remove and can cause great pain in patients. Constipation is pretty great also called obstipation. And severe obstipation can cause fatal intestinal cancer for patients.

Causes

Constipation or constipation is a complaint on the digestive system of the most common and is found in the wider community including around us. Even estimated that around 80% of people have experienced constipation or constipation. Common causes of constipation or constipation that is around us, among others:

• Lack of body fluids or dehydration.
• Hot suffer.
• Stress or depression and compact enough activity.
• Influence of hormones in the body (eg in menstruation or pregnancy).
• Bowel less elastic (usually because it is in the pregnancy or old age).
• Anatomic abnormalities in the digestive system.
• Lifestyle and irregular eating patterns (such as poor diet).
• Side effects from drinking something that contains a lot of calcium or aluminum (eg antidiare drugs, analgesics, and antacids).
• Lack of vitamin C intake and lack of fiber.
• Is a symptom of disease (eg, typhus and hernia).
• Often withhold stimulus to defecate in a long time.
• Emotion, because the emotion or anxiety intestines spasm, sehigga pertaltik intestine and large intestine absorbs stopped returning fluid feces. Consequently stool becomes hard.
• Rarely or less work.
• Advantages of fiber consumption.
• The advantages of eating meat. Especially red meat because it was difficult to digest and has a lot of iron. Iron is the substance that makes the hardening of feces, making it dark and black.
• Of drug abuse, such as drug laxatives. For example, the application of mineral oil is useful for launching peristaltic motion. Eventually the intestines become accustomed to and dependent on the drug, resulting in a slow intestinal reactions, and inhibits intestinal peristalsis self.
• Frozen foods save time and energy, but cause many health problems. Frozen foods have very low fiber and a lot of preservatives that can disrupt the bowel movement. Like ice cream barely contain fiber so it can help regulate bowel movements combined with sugar and milk in it can harden the stool.
• Eating certain fruits or vegetables that can compress excess dirt naturally like bananas.

Signs and symptoms

Symptoms and signs will vary from person to person, because of diet, hormones, lifestyle and shape of the large intestine of each person is different, but usually the symptoms and signs commonly found on most or sometimes some patients are as follows :

• Stomach feels full, and even feels numb manure pile (if manure has accumulated about 1 week or more, patients with stomach looks like being pregnant).
• Feces become harder, warm, darker, a little more than usual amount (less than 30 grams), and can even form a small bow when it is severe.
• At the time of bowel removed or discarded hard stools, sometimes must mengejan or pressing his stomach in advance so as to remove the feces (even to suffer hemorrhoid and cold sweat).
• Heard noises in the stomach.
• The anus feels full, and as something hampered accompanied with pain as a result of frictional heat and hard stools.
• Frequency throw up wind accompanied a more disagreeable odor than usual (even sometimes patients may have trouble or can not totally get rid of the wind).
• A decline in the frequency of bowel movements, and increased bowel transit time (usually defecate be 3 days or more).
• Sometimes experiencing nausea and even vomiting if it is severe.
• Back pain when feces accumulated quite a lot.
• Bad breath.

As for the psychological symptoms that can occur in the patients with constipation, among others:

• Lack of confidence
• Prefers to be alone or away from the vicinity.
• Still feel hungry but when eating faster satiety (especially when pregnant stomach will feel heartburn) because the space in the stomach is reduced.
• Emotion is increasing rapidly.
• Often pounding so fast that lead to emotional stress so vulnerable headaches or even fever.
• The body does not fit, uncomfortable, tired, tired quickly, and droop so lazy to do things sometimes even sleepy.
• Less zealous in carrying out the activity.
• Daily activities have been disrupted as a body feels overburdened resulting quality and decreased work productivity.
• Can decrease appetite.

Prevention

• Do not junk at an arbitrary point.
• Avoid foods that are high in fat and sugar.
• Drink at least 1.5 to 2 white liters of water (about 8 glasses) of fluid a day and others every day.
• Sports, such as walking (jogging) can be done. At least 10-15 minutes for light exercise, and at least 2 hours for a heavier workout.
• Familiarize defecate regularly and do not like to hold a bowel movement. No need to force a bowel movement every day when there is no stimulus for the digestive cycle every person differently.
• Consumption of foods that contain enough fiber, such as fruits and vegetables.
• Sleep at least 4 hours a day.
• Add herbal flavor in food, except chili.
• Diet is not excessive.
• Consuming anti-inflammatory foods, such as avocado, apples, and coconut.

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